Project Summary/Abstract The proposed study will evaluate the effectiveness of a novel model for pulmonary specialist-health coach (PS- HC) with respect to access to specialist recommendations and the provision of evidence-based care for patients with COPD and/or asthma receiving care at federally qualified health centers (FQHCs). The PS-HC model was developed in partnership between patients, investigators, primary care clinicians, specialists, and FQHCs within the San Francisco Health Care Network during a randomized controlled trial of health coaching for patients with moderate to severe COPD. In the PS-HC model, a trained, non-professional (unliscenced) health worker, meets with the patient at the patient's own clinic to gather extensive information needed by the pulmonary specialist to make an assessment and recommendation for evidence-based care for COPD and/or asthma. The health coach then meets with the hospital-based pulmonary specialist who can assess the patient and make evidence-based recommendations without requiring the patient to be seen. These recommendations are communicated electronically to the patient's PCP. The health coach communicates with the PCP and meets with the patient to explain the recommendations and support their implementation. The study will be conducted in the San Francisco Health Network, which includes 11 FQHCs with a shared electronic medical record and a single electronic referral process (eReferral) that allows the new model to be rolled out in successive waves over 3 years, creating the opportunity for a stepped randomly sequenced pre- post study design which allows for comparison of the PS-HC model to the usual care consultation and for the assessment of secular trends over the course of the study. The specific aims of the study are to compare the use of evidence-based care and of patient reported outcomes 3 months after the consultation. In addition, the study will evaluate the number of patients seen under each model and the cost per patient in each model. The PS-HC model combines desirable attributes of patient-centered care, team-based care, and coordinated specialty consultation to improve guideline-based care for at-risk patients with COPD and/or asthma. This model has been specifically developed to function within a safety-net system. It is designed to be practical and adaptable to other FQHCs and FQHC networks, and to be effective despite financial, technological, and resource constraints. If the proposed study shows that the PS-HC model increases the use of evidence-based care, it can be widely implemented to increase guideline concordant, evidence-based care not just for patients with COPD or asthma, but also with other conditions.